Does Medicare cover hepatitis C screening?

Who qualifies for a Medicare hepatitis C screening?

Hepatitis C screenings help find out if you're infected with the hepatitis C virus. Medicare Part B covers a screening if your primary care doctor or other health care provider orders one, and you meet at least one of these conditions:

• You're at high risk because you use or have used illicit injection drugs.
• You're at high risk because you had a blood transfusion before 1992.
• You were born between 1945 and 1965.

How often does Medicare cover hepatitis C screening?

Medicare Part B covers the screening once a year or once in your lifetime, depending on your risk:

• Once a year, if you're at high risk because you've continued to use illicit injection drugs since your previous negative hepatitis C screening test.
• Once in your lifetime, if you're at high risk because you had a blood transfusion before 1992 or you used illicit injection drugs in the past.
• Once in your lifetime, if you were born between 1945 and 1965 and aren't considered high risk.

Where do I get a Medicare hepatitis C screening?

CMS's national coverage determination says Medicare covers the screening when your primary care physician or practitioner orders it within the context of a primary care setting. CMS gives emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, clinics providing a limited focus of health care services, and hospice as examples of settings that aren't considered primary care settings.

CMS adds that your primary care physician or practitioner decides whether you're at high risk by assessing your history, which is typically part of an annual wellness visit. See what happens at a Medicare annual wellness visit.

What do I pay for hepatitis C screening with Medicare?

You pay nothing for a hepatitis C screening if your health care provider accepts assignment, and CMS lists no copayment, coinsurance or deductible for it. Your doctor may recommend services that Medicare doesn't cover, or more often than Medicare covers them, which could mean extra costs for you, so ask what Medicare will cover.

Does Medicare cover hepatitis B screening and vaccines too?

Yes. Medicare Part B covers a hepatitis B virus (HBV) infection screening if your doctor or other health care provider orders it and you're at high risk for HBV infection or you're pregnant, and you pay nothing if your provider accepts assignment. Part B also covers hepatitis B vaccines if you're eligible, and you pay nothing if your provider accepts assignment for giving the vaccine. See Medicare and the hepatitis B vaccine.

Does Medicare Advantage cover hepatitis C screening?

Medicare Advantage Plans must cover all medically necessary services that Original Medicare covers, and plans may also offer extra benefits that Original Medicare doesn't cover. Plans may have different out-of-pocket costs for certain services and may require you to use providers in the plan's network for non-emergency care, so check with the plan about where to get the screening.